Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

Side Effects and Adverse Reactions
The patient should be monitored by a public health nurse and/or clinician or case
manager at least monthly for signs and symptoms of adverse reactions until treatment is
completed. If a patient is symptomatic, the provider should be consulted and the patient
monitored more frequently. Chemistries and complete blood count (CBC), aspartate
aminotransferase (AST)/alanine aminotransferase (ALT), or other tests based on
specific drugs should be done periodically. See Table 4: Monitoring and Interventions
for Side Effects and Adverse Reactions in this section.
Adverse effects are fairly common and often manageable. Although it is important to be
attuned to the potential for adverse effects, and that the drugs with the highest evidence
rating not be stopped without adequate justification. 25 However, adverse reactions can
be severe, and thus, it is important to recognize adverse reactions that indicate when a
drug should not be used. Mild adverse effects can generally be managed with
symptomatic therapy; whereas with more severe effects, the offending drug or drugs
must be discontinued. 26 In addition, proper management of more serious adverse
reactions often requires expert consultation. 27
Monitor patients for side effects and adverse reactions following the basic monitoring
steps listed below.
Basic Monitoring Steps
1. Use the American Thoracic Society (ATS)/Centers for Disease Control and
Prevention (CDC) guidelines.
a. Follow the national monitoring guidelines identified in the current treatment
guidelines for treatment of LTBI, “Targeting Tuberculin Testing and Treatment of
Latent Tuberculosis Infection,” pages 26–29 at
http://www.cdc.gov/mmwr/PDF/rr/rr4906.pdf .
b. Check guideline updates posted on the CDC’s Division of Tuberculosis
Elimination home page at http://www.cdc.gov/tb/default.htm and the list of
guidelines by date at http://www.cdc.gov/tb/publications/guidelines/List_date.htm
2. Whenever possible, evaluate patients in person, at baseline (before starting
treatment), and then at least every month for side effects and adverse reactions.
A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Tr eatment of Latent Tuberculosis Infection
Revised November 2012
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